The burden of recording and reporting health data in primary health care facilities in five low- and lower-middle income countries.

BACKGROUND: Recording and reporting health data in facilities is the backbone of routine health information systems which provide data collected by health facility workers during service provision. Data is firstly collected in a register, to record patient health data and care process, and tallied into nationally designed reporting forms. While there is anecdotal evidence of large numbers of registers and reporting forms for primary health care (PHC) facilities, there are few systematic studies to document this potential burden on health workers. This multi-country study aimed to document the numbers of registers and reporting forms use at the PHC level and to estimate the time it requires for health workers to meet data demands. METHODS: In Cambodia, Ghana, Mozambique, Nigeria and Tanzania, a desk review was conducted to document registers and reporting forms mandated at the PHC level. In each country, visits to 16 randomly selected public PHC facilities followed to assess the time spent on paper-based recording and reporting. Information was collected through self-reports of estimated time use by health workers, and observation of 1360 provider-patient interactions. Data was primarily collected in outpatient care (OPD), antenatal care (ANC), immunization (EPI), family planning (FP), HIV and Tuberculosis (TB) services. RESULT: Cross-countries, the average number of registers was 34 (ranging between 16 and 48). Of those, 77% were verified in use and each register line had at least 20 cells to be completed per patient. The mean time spent on recording was about one-third the total consultation time for OPD, FP, ANC and EPI services combined. Cross-countries, the average number of monthly reporting forms was 35 (ranging between 19 and 52) of which 78% were verified in use. The estimated time to complete monthly reporting forms was 9 h (ranging between 4 to 15 h) per month per health worker. CONCLUSIONS: PHC facilities are mandated to use many registers and reporting forms pausing a considerable burden to health workers. Service delivery systems are expected to vary, however an imperative need remains to invest in international standards of facility-based registers and reporting forms, to ensure regular, comparable, quality-driven facility data collection and use.

One swallow does not a summer make: Twenty years of challenges and achievements of family medicine in Mozambique.

After 20 years of hard work, family medicine (FM) is flourishing in Mozambique, but the challenges are immense in a context of multiple health needs. This study aimed to describe strengths, opportunities, weaknesses and threats of the current scenario that can influence the development of FM and primary health care (PHC) in Mozambique. Case study of a series of virtual world-café meetings using the World Health Organization's Operational Framework for primary health care as a theoretical model. There is a young generation of Family Physicians (FPs) eager to improve PHC in Mozambique - a result of the reactivation of the Maputo Residency Programme and the creation of the Mozambican College of FP in 2010. The current Ministry of Health has taken this agenda forward, inviting medical societies (including FM) to jointly design plans to expand training of human resources for healthcare. This plan aims to create new training sites in five different provinces hoping that it will increase the number of FP in remote areas, fixing the unequal distribution of specialists in the country. The small number of FP practicing today and the limited financial resources of the National Government are important threats to this plan. We have many strengths already conquered and the current situation opens an opportunity for the expansion of FM in Mozambique. Hopefully, it will help PHC in our country move from verticalised and selective health programmes towards a more comprehensive, efficient and person-centred care.